Part 4 - Ralph Winstanley - FACTS about his death - 19Apr2004

Click for A Full Index - but stay on this page if you want to read the main facts

Table of FACTS in respect of Ralph Winstanley’s death
23Apr2004 - plus numerous supporting document abstracts

Fourth part - 19Apr2004

19Apr2004 - 08.45
FACT: Notes made by Hospice-at-Home nurse, RGN Carolyn Smith indicate that she had been informed that Ralph Winstanley had cancer of the oesophagus. She writes
‘? CA Oesophagus’
Lower down the page she notes
‘Gastroscopy March 2004; CA Oesophagus’
Hospice-at-Home - Office Notes, front page - RGN Carolyn Smith - No 44
NOTE WELL: Who told her this? Two separate Oesophageal biopsies had shown that Ralph Winstanley did not have any sign of malignancy in his oesophagus or stomach.
Doncaster & Bassetlaw NHS Trust - Pathology Services - No 1
Doncaster & Bassetlaw NHS Trust - Pathology Services - No 14
On this page, the person who referred Ralph Winstanley to her was stated as: ‘Julie Marshall’, though ‘Dr Brown’ is also noted as the doctor.
Also, notes on this page confirm that there was certainly only one syringe-driver in place at the time when RGN Carolyn Smith filled in this part of her record
‘S.D. Diamorphine + Haloperidol’
(Diamorphine and Haloperidol were both put into the same syringe-driver.)
Hospice-at-Home - Office Notes, front page - RGN Carolyn Smith - No 44

19Apr2004 - 09.10
Only one syringe-driver is shown as being refilled at this time, which shows that there was still only one syringe-driver in place.
Syringe-driver Form - RGN PA Jones - No 41a
NOTE WELL: It is certain that RGN PA Jones only checked one syringe-driver, making a note about its contents in the Syringe-driver Form. Had there been two in situ, she would have checked both – as happens in the rest of the form. Next recorded visit was not until 14.50

19Apr2004 - 09.10
Nursing Note made by RGN PA Jones makes mention of only one syringe-driver – and the fact that it is set up with Diamorphine and Haloperidol
Nursing Notes - abstract - RGN PA Jones - No 46a
Nursing Notes - abstract - RGN PA Jones - No 46b

19Apr2004 - 09.10
In her Community Intervention Team Office Notes, RGN PA Jones also makes no mention of Ralph Winstanley being observed to be unsettled, or in any pain. Her comment is that: ‘Patient appears comfortable’
These notes also contain no mention of Midazolam or of a second syringe-driver. They do mention that Ralph Winstanley is still being kept on Oramorph, in spite of his having been on Diamorphine and Haloperidol for 24 hours, both by injection and via syringe-driver.
Community Intervention Team Office Notes - RGN PA Jones - No 37b
NOTE WELL: No pain observed

Enough Midazolam to fill a syringe-driver with 60mg per 24 hours, was only dispensed on Monday 19Apr2004 by Danum Doctors. The prescription was for 10 packs of 10mg/2ml – 6 of which would be needed to fill a syringe-driver to dispense 60mg over 24 hours. (A further 22 packs dispensed on 20Apr2004)
(This shows that some of the Nursing Notes are erroneous)
Pharmacy Record in respect of Danum Doctors prescribing - Weldricks, East Laith Gate - No 43

19Apr2004 - 14.50
Nursing Notes still state ‘to check syringe-driver’ – in the singular. It also states ‘Dr Sykes had visited prior to our arrival and administered Midazolam due to Ralph’s agitation.’
Had there been a second syringe-driver in place at that time, there would have been no need to ‘administer Midazolam’, because the second syringe-driver would already have contained it.
This note continues by mentioning syringe-drivers, which seems to indicate that the second syringe-driver was due to be set up at this time, by District Nursing Sister Julie Marshall, who also states that ‘Dr Sykes has now increased dosage to 40mg Diamorphine, 60mg Midazolam Haloperidol 10mg. Drugs not available at time of visit.’Because of the entry at 17.00 – see below – it seems that the paragraph above, stated to have been made at 14.50 might have been made after Ralph Winstanley died. There is also the fact that this entry begins as 19/4/04 and continues over the page as 20/4/04, then returns to 19/4/04. Whoever wrote it seems to have been thoroughly confused.
Nursing Notes - abstract - District Nursing Sister Julie Marshall - No 47

19Apr2004 - 14.50-17.00
Hospice-at-Home Nurse, RGN Carolyn Smith’s main notes, seem to have been written after 14.50 on 19Apr2004.
District Nursing Sister Julie Marshall wrote in her Nursing Note of 14.50 ‘Hospice at Home due to visit this afternoon.’
Nursing Notes - abstract - District Nursing Sister Julie Marshall - No 47

RGN Carolyn Smith writes: ‘Ralph is in terminal phase of illness.’
Who told her this?
Hospice-at-Home Office Notes - RGN Carolyn Smith - No 45

19Apr2004 - 17.00
The first record of filling two syringe-drivers is at 17.00, when District Nursing Sister Julie Marshall marks them both down on the Syringe-driver Form for the first time, recording that she fills two syringe drivers each showing 44mm.
Nursing Notes - Syringe-driver Form - District Nursing Sister Julie Marshall - No 41a

19Apr2004 - 23.20
This last Community Intervention Team Office Note states: ‘Visit as requested to check syringe-driver commenced earlier by district team.’This shows exactly when the second syringe-driver was set up. ‘district team’ refers to District Nursing Sister, Julie Marshall and her team. The ‘district team’, (consisting only of District Nursing Sister Julie Marshall, on 19Apr2004) called twice that day. At 14.50 and 17.00. So it had to be on one of these occasions that the second syringe driver to contain Midazolam, was set up. There is confirmation in the Syringe-driver Form, that it was set up - for the first time - at 17.00
Nursing Notes - Syringe-driver Form - District Nursing Sister Julie Marshall - No 41a
NOTE WELL: No pain observed

FACT: RGN J Hopkinson also agrees that from her own observation: ‘Mr Winstanley settled and pain free’.
Community Intervention Team Office Notes - RGN J Hopkinson - 2nd note - No37b
NOTE WELL: So why was his drug dose increased at13.35 on 20Apr2004, by Dr Sykes?

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Protest songs and poems - coming shortly

  • A Full Index
  • Abide With Me (mine)
  • Dead An Buried? Ardly!
  • Director of Public Health - Dr Tony Baxter
  • If - (not by Rudyard Kipling)
  • Jayne Brown - The Cover-Up Woman
  • Practice - Field Road Made
  • Quack Quack Dr Lee
  • St John's Hospice - My Father Was Not Dying
  • Thanksgivin? Thanksgivin? Ah'll be Waitin On
  • The NHS/PCT Thinks You Should Go
  • The Palliative Gillian
  • The Power behind the Patient Dr Brown

Who was Ralph Winstanley?

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